MOPH Annual Training, Spring 2011, Orlando, FL 03/28/2011 Pat Byers

Transcription

1 A Summary of Dental Benefits for Veterans MOPH Annual Training, Spring 2011, Orlando, FL 03/28/2011 Pat Byers

2 Objectives Who is Eligible & What they are Eligible for? Classes of Treatment Inpatient Treatment Emergency Outpatient Treatment One Time Treatment for Certain Veterans Dental Conditions secondary to other S/C Conditions MOPH NSO Annual Training, Spring 2011, Orlando, FL,. 2

3 Scenario 1 A veteran is currently receiving temporary I/U with a future evaluation of August 28, 2011, because she is enrolled in the VA Inpatient PTSD program for 91 days. She is experiencing pain from a left lower wisdom tooth that was never removed and also has a cavity in the lower left canine tooth that is causing no pain. She is Service Connected for trauma to the upper right molar. Is this veteran entitled to any dental care and if so, what is she entitled too? MOPH NSO Annual Training, Spring 2011, Orlando, FL. 3

4 Scenario 2 This same veteran has completed her PTSD Treatment program and has been released from the hospital. She is having complications from the wisdom tooth removal and surgery, and the cavity in her lower left canine has started to cause her much pain and discomfort. Is she entitled to any dental care and if so, what is she entitled too? MOPH NSO Annual Training, Spring 2011, Orlando, FL 4

5 Scenario 3 A veteran that is rated Permanently Disabling is in need of Dental Care. Is this veteran entitled to any dental care and if so, what are they entitled too, and where do they submit their request for treatment? MOPH NSO Annual Training, Spring 2011, Orlando, FL 5

6 Scenario 4 A veteran has recently left the service within the past 93 days. He informs you that he had trauma to his upper right Incisors in Iraq. He was provided a dental exam prior to being honorably discharged, but did not receive any treatment according to his DD Form 214. Is this veteran entitled to any dental care & what guidance as a Service Officer can we provide to this veteran? MOPH NSO Annual Training, Spring 2011, Orlando, FL 6

7 Eligibility & Classes The Eligibility for Outpatient Dental Care is not the same as most other VA Benefits and is Categorized into Classes. These Classes are (I, II, IIA, IIB, IIC, III, IV, V, and VI) If a Veteran is Eligible for VA Dental Care under Classes I, IIC, or IV, they are eligible for any necessary Dental Care to maintain or restore Oral Health and Masticatory Function including Repeat Care. Other Classes have Time and/or Service Limits. MOPH NSO Annual Training, Spring 2011, Orlando, FL 7

8 Who is Eligible? Public Law 83 enacted June 16, 1955, amended Veterans Eligibility for Outpatient Dental Care. As a result, any veteran who received a Dental Award Letter from the VBA dated before 1955 in which the VBA determined the Dental Condition to be Non Compensable are No Longer eligible for Class II Outpatient Dental Treatment. MOPH NSO Annual Training, Spring 2011, Orlando, FL 8

9 Eligibility & Classes Veterans that Have a Service Connected Compensable Dental Disability or Condition are assigned to Class I and are Eligible for Any Needed Dental Care. Veterans that are a Former Prisoner of War are assigned to Class IIC and are Eligible for Any Needed Dental Care. MOPH NSO Annual Training, Spring 2011, Orlando, FL 9

10 Eligibility & Classes Veterans who Apply for Dental Care within 180 days of Discharge or release from a Period of Active Duty of 90 Days or more during the Persian Gulf War Era (Under conditions under than Dishonorable) are assigned to Class II. These Veterans are Entitled to One Time Dental care if their DD Form 214 does not indicate that a Complete Dental Examination and all Appropriate Dental Treatment has been rendered prior to discharge. MOPH NSO Annual Training, Spring 2011, Orlando, FL 10

11 Eligibility & Classes Veterans who have a Service Connected Non Compensable Dental Condition or Disability Resulting from Combat Wounds or Service Trauma are assigned to Class IIA. These Veterans are Entitled to Needed Care for the Service Connected Condition (s). A Dental Trauma Rating (VA Form D) or VARO Rating Decision Letter (VA Form ) Identifies the Tooth/Teeth that are Eligible for Care. MOPH NSO Annual Training, Spring 2011, Orlando, FL 11

12 Eligibility & Classes A Enrolled Veteran that may be Homeless and Receiving Care under VHA Directive is assigned to Class IIB. These Veterans are eligible for: A One Time course of Dental Care Medically necessary to relieve pain, assist the Veteran to gain employment, or treat Moderate, Severe, or Complicated and Severe Gingival and Periodontal Conditions. VHA Directive is Included in your Handouts. MOPH NSO Annual Training, Spring 2011, Orlando, FL 12

13 Eligibility & Classes Veterans with a Dental Condition Clinically determined by VA to be associated with and aggravating a Service Connected Medical Condition is assigned to Class III. These Veterans are Entitled to Dental Care to treat the Oral Conditions that are determined by a VA Dental Professional to have a Direct & Material Detrimental Effect to the Service Connected Medical Condition. MOPH NSO Annual Training, Spring 2011, Orlando, FL, 13

14 Eligibility & Classes Veterans that have S/C Disabilities rated at 100% Disabling or is in receipt of Individual Unemployability are assigned to Class IV and are Eligible for Any Needed Dental Care. Note: Veterans that are in Receipt of a Temporary 100% Rate are not Eligible for Comprehensive Outpatient Dental Services. MOPH NSO Annual Training, Spring 2011, Orlando, FL, 14

15 Eligibility & Classes A Veteran that is Actively Engaged in a Title 38 USC Chapter 31 Vocational Rehabilitation Program is assigned to Class V. These Veterans are eligible for Dental Care to the extent necessary as determined VA Dental Professional to: Make Possible your entrance into a Rehabilitation Program. Achieve the goals of their Rehabilitation Program. Prevent Interruption of their Rehabilitation Program. Hasten the Return to a Rehabilitation Program if the Veteran is in Interrupted or Leave Status. MOPH NSO Annual Training, Spring 2011, Orlando, FL 15

16 Eligibility & Classes Class V Continued Hasten the return to a Rehabilitation Program of a Veteran placed in Discontinued Status because of Illness, Injury or a Dental Condition, or Secure and Adjust to Employment during the period of Employment Assistance, or enable the Veteran to achieve Maximum Independence in Daily Living. MOPH NSO Annual Training, Spring 2011, Orlando, FL 16

17 Eligibility & Classes A Veteran Receiving VA Care or is Scheduled for Inpatient Care and requires Dental Care for a condition complicating a Medical Condition currently under treatment is assigned to Class VI. These Veterans are eligible for: Dental Care to treat the Oral Condition that are determined by a VA Dental Professional to Complicate the Medical Condition currently under treatment. MOPH NSO Annual Training, Spring 2011, Orlando, FL 17

18 Emergency Outpatient 38 CFR Emergency outpatient dental treatment. When outpatient emergency dental care is provided as a humanitarian service, to individuals who have no established eligibility for outpatient dental care, the treatment will be restricted to the alleviation of pain or extreme discomfort, or the remediation of a dental condition which is determined to be endangering life or health. The provision of emergency treatment to persons found ineligible for dental care will not entitle the applicant to further dental treatment. Individuals provided emergency dental care who are found to be ineligible for such care will be billed. MOPH NSO Annual Training, Spring 2011, Orlando, FL 18

19 Inpatient Dental Care 38 CFR Dental services for hospital or nursing home patients and domiciled members. Persons receiving hospital, nursing home, or domiciliary care pursuant to the provisions of 38 CFR and 38 CFR 17.47, will be furnished such dental services as are professionally determined necessary to the patients' or members' overall hospital, nursing home, or domiciliary care. MOPH NSO Annual Training, Spring 2011, Orlando, FL 19

20 Post Hospital Treatment 38 CFR Post Hospital outpatient dental treatment. The Chief, Dental Service may authorize outpatient dental care which is reasonably necessary to complete treatment of a non service connected dental condition which was begun while the veteran was receiving Department of Veterans Affairs authorized Hospital Care. MOPH NSO Annual Training, Spring 2011, Orlando, FL 20

21 Scenario 1 A veteran is currently receiving temporary I/U with a future evaluation of August 28, 2011, because she is enrolled in the VA Inpatient PTSD program for 91 days. She is experiencing pain from a left lower wisdom tooth that was never removed and also has a cavity in the lower left canine tooth that is causing no pain. She is Service Connected for trauma to the upper right molar. Is this veteran entitled to any dental care and if so, what is she entitled too? MOPH NSO Annual Training, Spring 2011, Orlando, FL 21

22 Scenario 1 Answer She is entitled to treatment in CL VI if a VA Dental Professional determines that the Wisdom Tooth is complicating her PTSD or treatment for PTSD. She also meets the requirements of 38 CFR that covers dental services for hospital or nursing home patients and domiciled members. She is not entitled to dental treatment based on her Temporary Individual Unemployability. Her S/C dental trauma only covers her upper right molar. MOPH NSO Annual Training, Spring 2011, Orlando, FL 22

23 Scenario 2 This same veteran has completed her PTSD Treatment program and has been released from the hospital. She is having complications from the wisdom tooth removal and surgery, and the cavity in her lower left canine has started to cause her much pain and discomfort. Is this veteran entitled to any dental care and if so, what is she entitled too? MOPH NSO Annual Training, Spring 2011, Orlando, FL 23

24 Scenario 2 Answer She may be entitled to treatment under 38 CFR which allows treatment that is reasonably necessary to complete the treatment for NSC dentals conditions which began while the veteran was receiving DVA Authorized Hospital Care. I would argue that she is in this case. She is not SC for her Lower Left Canine and is not entitled to Comprehensive Dental Treatment. She could be entitled to emergency outpatient dental treatment under 38 CFR but she may be billed for the treatment if she is found to be ineligible. MOPH NSO Annual Training, Spring 2011, Orlando, FL 24

25 Scenario 3 A veteran that is rated Permanently Disabling is in need of Dental Care. Is this veteran entitled to any dental care and if so, what are they entitled too, and where do they submit their request for treatment? MOPH NSO Annual Training, Spring 2011, Orlando, FL 25

26 Scenario 3 Answer Veterans that have S/C Disabilities rated at 100% Disabling or is in receipt of Individual Unemployability are assigned to Class IV and are Eligible for Any Needed Dental Care. The request for Dental Service is submitted to the VA Health Care Facility, not the VARO in the form of a S/C Claim. MOPH NSO Annual Training, Spring 2011, Orlando, FL 26

27 Scenario 4 A veteran has recently left the service within the past 93 days. He informs you that he had trauma to his upper right Incisors in Iraq. He was provided a dental exam prior to being honorably discharged, but did not receive any treatment according to his DD Form 214. Is this veteran entitled to any dental care & what guidance as a Service Officer can we provide to this veteran? MOPH NSO Annual Training, Spring 2011, Orlando, FL 27

28 Scenario 4 Answer Veterans who Apply for Dental Care within 180 days of Discharge or release from a Period of Active Duty of 90 Days or more during the Persian Gulf War Era (Under conditions under than Dishonorable) are assigned to Class II. They are Entitled to One Time Dental care if their DD Form 214 does not indicate that a Complete Dental Examination and all Appropriate Dental Treatment has been rendered prior to discharge. He may possibly meet the requirements of Class IIA. We should try and develop for possible S/C dental trauma for his upper right Incisors while the veteran was in Iraq. MOPH NSO Annual Training, Spring 2011, Orlando, FL 28

29 38 CFR References Authorization of dental examinations Authorization of outpatient dental treatment Eligibility for Class II dental treatment without rating action Post Hospital outpatient dental treatment Patient responsibility in making and keeping dental appointments Emergency outpatient dental treatment Dental services for hospital or nursing home patients and domiciled members. MOPH NSO Annual Training, Spring 2011, Orlando, FL 29

30 38 USC References A 1710B Eligibility for hospital, nursing home, and domiciliary care. Required nursing home care. Extended care services. Care during examinations and in emergencies. Dental care; drugs and medicines for certain disabled veterans; vaccines. MOPH NSO Annual Training, Spring 2011, Orlando, FL 30

31 M21 References M21 1, Manual Rewrite, Part III, Subpart V, Chapter 7, Section A M21 1, Manual Rewrite, Part IX, Subpart II, Chapter 2, Section 2 VHA Directive VHA Handbook VHA References MOPH NSO Annual Training, Spring 2011, Orlando, FL 31

32 Summary & Questions Thank You, Have a Great Week (253) MOPH NSO Annual Training, Spring 2011, Orlando, FL 32